Osteopathic Journal ClubREVIEW

The Glymphatic-Lymphatic Continuum: Opportunities for Osteopathic Manipulative Medicine

Kyle Hitscherich, OMS II; Kyle Smith, OMS II; Joshua A. Cuoco, MS, OMS II; Kathryn E. Ruvolo, OMS III; Jayme D. Mancini, DO, PhD; Joerg R. Leheste, PhD; and German Torres, PhD
Notes and Affiliations
Notes and Affiliations

Accepted: August 25, 2015

Published: March 1, 2016

J Osteopath Med; 116(3): 170-177

The brain has long been thought to lack a lymphatic drainage system. Recent studies, however, show the presence of a brain-wide paravascular system appropriately named the glymphatic system based on its similarity to the lymphatic system in function and its dependence on astroglial water flux. Besides the clearance of cerebrospinal fluid and interstitial fluid, the glymphatic system also facilitates the clearance of interstitial solutes such as amyloid-β and tau from the brain. As cerebrospinal fluid and interstitial fluid are cleared through the glymphatic system, eventually draining into the lymphatic vessels of the neck, this continuous fluid circuit offers a paradigm shift in osteopathic manipulative medicine. For instance, manipulation of the glymphatic-lymphatic continuum could be used to promote experimental initiatives for nonpharmacologic, noninvasive management of neurologic disorders. In the present review, the authors describe what is known about the glymphatic system and identify several osteopathic experimental strategies rooted in a mechanistic understanding of the glymphatic-lymphatic continuum.

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